Automated Prior Authorization Catches On

Erin M. Burns, PhD, MSPH
Published: Tuesday, Mar 17, 2020
Abdallah, PharmD

Karina Abdallah, PharmD

The manual labor involved in obtaining prior authorizations (PAs) is a well-recognized burden among providers. Up to 46% of PA requests are still submitted by fax, and 60% require a telephone call, according to America’s Health Insurance Plans (AHIP).1 A 2018 survey by the American Medical Association (AMA) found that doctors and their staff spend an average of 2 days a week completing PAs.2 In addition to eating up time that physicians could spend with patients, PAs also contribute to burnout.

MGMA findings also indicated that PA processes at provider practices remain largely manual: 52% are fully manual, 36% are partially electronic, and 12% are fully electronic. 4 However, software is now available to help synchronize electronic health records (EHRs) with payer portals and automate the PA process.

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In January, AHIP in collaboration with payers representing 60 million covered individuals launched the Fast Prior Authorization Technology Highway (Fast PATH) to improve the PA process. The system lets providers access a patient’s benefit entitlements and, if required, submit PA requests directly through the EHR. Payers in this initiative include Anthem, Blue Shield of California, Cambia’s affiliated health plans, Cigna, Florida Blue, and WellCare.1

Various software vendors are stepping into this space. Recondo said in a 2019 release that its AuthInitiate system could reduce average time spent on PA requests “from a manual 25 minutes to less than 3 minutes.”5

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